Introduction
The interaction between co-infections and HIV infection has been shown to be a central theme in understanding the mechanisms of HIV acquisition, progression to AIDS, and the efficacy of antiretroviral therapies. Recent studies indicate that factors such as pre-existing immunosuppression and inflammation, often caused by non-HIV infections, play critical roles in HIV susceptibility and response to antiretroviral treatment (Root-Bernstein, 2024). This section examines the main immunological implications of these co-infections and their impacts in the context of HIV.
Development
1. Coinfections as Predisposing Factors
Coinfections, such as tuberculosis, cytomegalovirus (CMV), syphilis, and other sexually transmitted infections (STIs), increase the expression of CCR5 and CXCR4 receptors on CD4+ T cells and monocytes, facilitating HIV entry (Root-Bernstein, 2024). Chronic inflammation caused by these infections creates an immunological environment conducive to viral replication, reducing immune resilience.
2. Changes in the Immune Profile
Individuals exposed to co-infections present alterations in their immune profile, such as inversion of the CD4/CD8 ratio and increased inflammatory markers. These alterations compromise the ability of the immune system to fight infections and respond to antiretroviral treatment. For example, untreated CMV co-infection during antiretroviral therapy reduces CD4 cell recovery and increases systemic inflammation (Freeman et al., 2016).
3. Implications for Therapy and Prophylaxis
The efficacy of pre-exposure prophylaxis (PrEP) and antiretroviral therapies may be compromised in contexts of chronic inflammation. Studies show that patients with high levels of inflammatory biomarkers before seroconversion have reduced responses to therapy, indicating the need for parallel management of co-infections to optimize outcomes (Root-Bernstein, 2024).
Discussion
The evidence presented underscores the importance of considering co-infections in the clinical management of HIV. Implementing preventive strategies, such as STI control and administration of therapies aimed at reducing inflammation, can significantly increase the effectiveness of HIV interventions. Furthermore, it is essential to integrate screening and treatment of co-infections into the care protocol for individuals living with HIV to improve therapeutic response.
References
Root-Bernstein, R. (2024). Coinfections increase the risk of HIV acquisition, AIDS progression, and therapy and prophylaxis failure: a review. Academia Medicine, 1, 1–12. https://doi.org/10.20935/AcadMed7295
Freeman, M.L., et al. (2016). CD8 T-cell expansion and inflammation linked to CMV coinfection in ART-treated HIV infection
